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Board Study Topics > 00 Hypertension > Flashcards

00 Hypertension Flashcards

1
Q

What blood pressure is considered “Pre-Hypertension”?

A

S: 120-139 or D: 80-89

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2
Q

What blood pressure is considered “Stage 1 Hypertension”?

A

S: 140-159 or 90-99

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3
Q

For the general population > 60 years, when should BP treatment be initiated?

A

SBP: 150+ or DBP: 90+

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4
Q

For the general population < 60 years, when should BP treatment be initiated?

A

SBP: 140+ or DBP: 90+

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5
Q

For 18+ years with CKD, when should BP treatment be initiated?

A

SBP: 140+ or DBP: 90+

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6
Q

For 18+ years with diabetes, when should BP treatment be initiated?

A

SBP: 140+ or DBP: 90+

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7
Q

What is recommended for initial treatment in the general population +/- DM (non-black)?

A

Thiazide diuretic, CCB, ACE-I, ARB

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8
Q

What is recommended for initial treatment in 18+ years, CKD, any race, +/- DM?

A

ACE-I or ARB (both of these could be initial or add-on to improve kidney outcomes)

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9
Q

What is recommended for initial treatment in the general black population?

A

Thiazide diuretic, CCB

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10
Q

If a loop and thiazide are given together, how must you space them?

A

Thiazide first, followed by loop one hour later

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11
Q

How do thiazides work?

A

Inhibits sodium reabsorption in the DISTAL CONVOLUTED TUBULES –> increase water excretion

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12
Q

What is the generic name for Diuril?

A

Chlorothiazide (Thiazide)

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13
Q

What is the generic name for Lozol?

A

Indapamide (Thiaizde)

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14
Q

What is the generic name for Zaroxolyn?

A

Metolazone (Thiaizde)

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15
Q

What is the generic name for Thalitone?

A

Chlorthalidone (Thiazide)

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16
Q

What is the only thiazide that can be given IV?

A

Diuril (Chlorothiazide)

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17
Q

What are the only thiazides that are effective when CrCl < 30?

A

Lozol (Indapamide) and Zaroxolyn (Metolazone)

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18
Q

What are the electrolyte imbalances caused by thiazides?

A

Hypo: K, Na, Mg, Cl. Hyper: Ca

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19
Q

What are the metabolic ADRs caused by thiazides?

A

Hyperglycemia, hyperuricemia, hypercholesterolemia. Photosensitivity

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20
Q

What are the contraindicates to thiazide use?

A

Sulfa allergy, Anuria, Renal decomposition, Pregnancy

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21
Q

What is the MOA of loop diuretics?

A

Inhibits Na and Cl reabsorption in the ASCENDING LOOP OF HENLE and the distal renal tubule –> increased water excretion

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22
Q

What is the generic name of Lasix?

A

Furosemide (loop)

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23
Q

What is the generic name of Demadex?

A

Torsemide (loop)

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24
Q

What is the generic name of Bumex?

A

Bumetanide (loop)

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25
Q

What is the generic name of Edecrin?

A

Ethacrynic Acid (loop) - only loop and thiazide that has no precaution with sulfa allergy

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26
Q

What are the Oral Loop Equivalents?

A

40 furosemide ~ 1 bumetanide ~ 10-20 torsemide

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27
Q

Whats unique about the IV formulations of loop diuretics?

A

They are light sensitive

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28
Q

What are the electrolyte imbalances caused by Loops?

A

Hypo: Na, K, Mg, Cl, AND Ca

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29
Q

When are Loops contraindicated?

A

Anuria

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30
Q

What is the BBW with Loops?

A

Excessive amounts –> profound diuresis –? fluid/electrolyte depletion

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31
Q

What is the MOA of Potassium Sparing/Aldosterone Antagonist Diuretics?

A

Competitive aldosterone antagonist in the distal renal tubule, leads to increase in Na, Cl, and water excretion while conserving K and H ions

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32
Q

What is the generic name of Midamor?

A

Amiloride (K-Sparing)

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33
Q

What is the generic name of Dyrenium?

A

Triamterene (K-Sparing)

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34
Q

What is the generic name of Inspra?

A

Eplerenone (Aldosterone Antagonist)

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35
Q

What is the generic name of Aldactone?

A

Spironolactone (Aldosterone Antagonist)

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36
Q

What is the only route that K-sparing and aldosterone antagonists can be give?

A

PO

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37
Q

How do Eplerenone and Spironolactone compare?

A

Eplerenone is ~100 times more potent than spironolactone

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38
Q

What electrolyte imbalance can be caused by k-sparing/aldosterone antagonists?

A

Hypo: Na, Mg

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39
Q

What is a unique ADR of Triamterene?

A

Nephrolithiasis

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40
Q

What is a unique ADR of Spironolactone?

A

Gynecomastia

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41
Q

What is the BBW with Spironolactone?

A

Tumorigenic

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42
Q

What is the BBW for both K-sparing diuretics?

A

Potentially fatal hyperkalemia

43
Q

What is the generic name of Lotensin?

A

Benazepril (ACE-I)

44
Q

What is the generic name of Capoten?

A

Captopril (ACE-I)

45
Q

What is the generic name of Vasotec?

A

Enalapril (PO), Enalaprilat (IV) (ACE-I)

46
Q

What is the generic name of Prinivil, Zestril?

A

Lisinopril (ACE-I)

47
Q

What is the generic name of Altace?

A

Ramipril (ACE-I)

48
Q

What is the only ACE-I that comes in IV form?

A

Enalaprilat

49
Q

What are some common ADRs with ACE-I?

A

CAPTOPRIL: Cough, Angioedema, Pancreatitis/Proteinuria, Taste loss, Orthostatic hypotension, Pregnancy category D, Renal failure/rash, Increased potassium, Lithium increases

50
Q

What is the generic name of Atacand?

A

Candesartan (ARB)

51
Q

What is the generic name of Cozaar?

A

Losartan (ARB)

52
Q

What is the generic name of Benicar?

A

Olmesartan (ARB)

53
Q

What is the generic name of Diovan?

A

Valsartan (ARB)

54
Q

What is the generic name of Tekturna?

A

Aliskiren (Direct Renin Inhibitor)

55
Q

What is the generic name of Norvasc?

A

Amlodipine (CCB)

56
Q

What is the generic name of Plendil?

A

Felodipine (CCB)

57
Q

What is the generic name of Cardene?

A

Nifedipine (CCB)

58
Q

What is the generic name of Sular?

A

Nisoldipine (CCB)

59
Q

What is the only DHP-CCB that can be given IV?

A

Cardene (Nicardipine)

60
Q

What are some common ADRs with DHP-CCBs?

A

Peripheral edema, Reflex tachycardia (mostly with Nicardipine and Nisoldipine), Flushing, HA/dizziness, Gingival hyperplasia, Rash

61
Q

What are DDI’s like with DHP-CCBs?

A

All of them are substrates of 3A4

62
Q

What is the generic name of Cardizem?

A

Diltiazem (Non-DHP CCB)

63
Q

What are some other brand names of Diltiazem?

A

Dilacor, Diltia, Tiazac, Taztia

64
Q

What is the generic name of Calan?

A

Verapamil (Non-DHP CCB)

65
Q

What is the most common ADR with Diltiazem?

A

HA and flushing

66
Q

What is the most common ADR with Verapamil?

A

Constipation and Gingival hyperplasia

67
Q

What are the DDI’s like with Non-DHP CCBs?

A

Both 3A4 substrates and inhibitors

68
Q

What is the generic name of Tenormin?

A

Atenolol (b1-selective BB)

69
Q

What is the generic name of Lopressor?

A

Metoprolol Tartrate (b1-selective BB)

70
Q

What is the generic name of Brevibloc?

A

Esmolol (b1-selective BB)

71
Q

What is the generic name of Toprol XL?

A

Metoprolol Succinate (b1-selective BB)

72
Q

What is the generic name of Bystolic?

A

Nebivolol (b1-selective BB AND increases NO production–> vasodilation)

73
Q

What are the B1-Selective BBs?

A

“No AMEBBA”: Nebivolol, Atenolol, Metoprolol, Esmolol, Betaxolol, Bisoprolol, Acebutolol

74
Q

Which type of BB’s cause more bradycardia?

A

B1-selective

75
Q

Which type of BB’s are a more suitable consideration for patients with asthma?

A

B1-selective

76
Q

What is the generic name of Sectral?

A

Acebutolol (partial b-receptor agonist w/ ISA activity)

77
Q

What is the generic name of Visken?

A

Pindolol (partial b-receptor agonist w/ ISA activity)

78
Q

What are the Partial B-receptor agonist BB’s with Intrinsic Sympathomimetic Activity (ISA)?

A

“CAPP”: Carteolol, Acebutolol, Penbutolol, Pindolol

79
Q

Which BB’s have high lipid solubility?

A

Propranolol, Penbutolol, Carvedilol

80
Q

What are the ADRs with BB’s that have high lipid solubility?

A

Cross BBB easier, more CNS side effects: sedation, mental confusion, nightmares. Increased first past metabolism, shorter duration of action

81
Q

What are the contraindications to BB use?

A

2nd/3rd degree heart block. Sinus bradycardia (HR < 50-55). Severe/uncontrolled asthma. Decompensated cardiac failure. Pregnancy. Caution in diabetics d/t masking hypoglycemia symptoms

82
Q

What is the generic name of Coreg?

A

Carvedilol (combined non-selective a/b blocker)

83
Q

What is the generic name of Normodyne, Trandate?

A

Labetalol

84
Q

How should patients take Carvedilol?

A

With food

85
Q

What is the generic name of Minipress?

A

Prazosin (a-1 blocker)

86
Q

What is the generic name of Hytrin?

A

Terazosin (a-1 blocker)

87
Q

What is the generic name of Cardura?

A

Doxazosin (a-1 blocker)

88
Q

What are some common ADRs with a-1 blockers?

A

Orthostatic hypotension (including “1st” dose phenomenon). Sodium and fluid retention

89
Q

What are a-1 blockers contraindicated?

A

With concurrent use of PDE-5 inhibitors

90
Q

What is the generic name of Catapress?

A

Clonidine (central/peripheral acting a-2 adrenergic agonist)

91
Q

What is the generic name of Kapvay?

A

Clonidine ER (central/peripheral acting a-2 adrenergic agonist)

92
Q

What is the generic name of Aldomet?

A

Methyldopa (central/peripheral acting a-2 adrenergic agonist)

93
Q

What is the generic name of Serpasil?

A

Reserpine (central/peripheral acting a-2 adrenergic agonist)

94
Q

What are some common ADRs with clonidine?

A

Sedation (tolerance does not develop), orthostatic hypotension, dry mouth, constipation

95
Q

When is methyldopa contraindicated?

A

Active liver disease. Concurrent use of MAO-I

96
Q

When is reserpine contraindicated?

A

Active GI disease (eg ulcers, etc), depression, severe renal failure, ulcerative colitis

97
Q

What is the generic name of Apresoline?

A

Hydralazine (direct vasodilator)

98
Q

What is the generic name of Loniten?

A

Minoxidil (direct vasodilator)

99
Q

What is a unique ADR of Minoxidil?

A

Hirsutism

100
Q

What medications are used for Hypertensive Urgency?

A

PO Medications: Captopril, Clonidine, Labetalol. Reduce BP gradually over 24-48 hours to safe levels (<160/100)

101
Q

What medications are used for Hypertensive Urgency?

A

Use IV meds: Sodium nitroprusside, Nitroglycerine, Labetolol, Esmolol, Propranolol, Nicardipine, Clevidipine, Fenoldopam mesylate, Hydralazine, Phentolamine, Enalaprilat

102
Q

What is the general recommendation for HTN in pregnancy?

A

Start with methyldopa or labetalol (methyldopa is still DOC). If additional treatment is needed: long acting CCB Nifedipine is safe. NO ACE-I, ARBs, DIRECT RENIN INHIBITOR!!!

103
Q

What is the DOC for preeclampsia?

A

Hydralazine

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